Provider Demographics
NPI:1154733970
Name:JACK ROMANO, LMFT, LLC
Entity type:Organization
Organization Name:JACK ROMANO, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-558-4141
Mailing Address - Street 1:462 TORRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2707
Mailing Address - Country:US
Mailing Address - Phone:203-558-4141
Mailing Address - Fax:
Practice Address - Street 1:416 HIGHLAND AVE
Practice Address - Street 2:BUILDING B, OFFICE A
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-558-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty